What The Health Care Bill Could Do For You

For more on the fine print contained in the new health care legislation, host Scott Simon talks with Jonathan Oberlander, health care policy expert at the University of North Carolina.

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SCOTT SIMON, host:

This is WEEKEND EDITION from NPR News. I'm Scott Simon.

Throughout today's program we'll be discussing the new health care law and its implications. For more on the print - both bold and fine - in that legislation we turn to Jonathan Oberlander. He teaches health care politics at the University of North Carolina Chapel Hill. He joins us from the Carolina News studios there. Welcome to the program, sir.

Professor JONATHAN OBERLANDER (University of North Carolina Chapel Hill): Thanks for having me.

SIMON: You know, we've heard a lot about provisions in the bill that go into effect for a matter of months, like keeping insurance companies from dropping children with preexisting conditions. But a lot of major provisions won't go into effect for four years or even more. Provisions like what?

Prof. OBERLANDER: Well, the most important provisions that are delayed are the expansions of insurance coverage, and there are two main ways that the legislation expands insurance coverage. One is to really broaden eligibility for Medicaid, and about 16 million Americans are going to gain access to the Medicaid program. That doesn't happen until 2014.

In addition, these new health insurance exchanges, which are going to be run at the state level and are sort of regulated marketplaces where the uninsured and small businesses would shop for health insurance, those don't get up and running until 2014 as well.

SIMON: People already covered by their employer, well, how realistic is the concern that they might lose coverage as companies look to reduce cost so they can cover more people?

Prof. OBERLANDER: I think for the most part, people with employer-sponsored insurance are going to stay on employer-sponsored insurance. If you look at the estimates by the Congressional Budget Office, what they predict over the next decade is that this is going to be really stable, that there's not going to be a big erosion.

In fact, I think one of the issues and one of the problems with this legislation is not that people with employer-sponsored insurance are likely to lose their coverage but generally they're not going to have access to these new health insurance exchanges unless they work for very small companies, and that means that they won't be able to choose from these new plans.

SIMON: Particularly in the last few weeks of the debate, the administration and President Obama seemed to really hammer the insurance companies for what they consider to be not keeping the public interest in mind and cutting off people from coverage. When all the political dust has settled, don't the insurance companies have the prospect of a lot more business ahead?

Prof. OBERLANDER: They do, and that is why from the outset insurance industry really welcomed a prospect of health reform. Their major business is in employer-sponsored health insurance coverage. And a decade ago, 69 percent of American companies provided health insurance to their workers. Now, it's only 60 percent. So, from their financial perspective, they really need to stabilize this market and the prospect of the government subsidizing coverage for 32 million Americans is a good one for them. Unless you're...

SIMON: I mean, that's like Coca-Cola being told they can start selling in China.

Prof. OBERLANDER: Well, it is with the proviso if Coca-Cola was told what ingredients they could put in and how much sugar and so forth. Because the tradeoff that the insurance industry is getting here is there's going to be a lot of regulation. This legislation really represents a transformation of how private health insurance operates in the United States. They will no longer be able to turn away sick people. They can't charge people much higher premiums because they have a preexisting condition.

So, that's a real tradeoff and that's why part of the insurance industry soured on this legislation.

I think there's one more point that's worth making. And that is unless you're expanding coverage through something like single payer Medicare for all, the insurance industry is going to gain new customers, because covering uninsured people means that you're going to expand private health insurance. So, you could think of this as a win-win: a win for the insurance industry and getting more customers but a win for the country in getting more health security.

SIMON: And do drug companies have cause to be happy?

Prof. OBERLANDER: I think they do. They played a very interesting role in this debate. They have a lot of money, they're very politically sophisticated, and early on they made a decision to join the health reform bandwagon. And I would say the most effective commercials on television - I saw this here for health reform - were actually paid for by the drug industry, by Pharma.

So, they did volunteer some savings over the next decade but they're also going to get a much expanded base of coverage. And, like the insurance industry, they're going to be happy that there's no public insurance option; they're going to be happy that there's no reimportation of drugs. So, they did very well.

SIMON: Jonathan Oberlander, a health care policy expert, University of North Carolina, and author of the book "The Political Life of Medicare." Thanks so much.

Prof. OBERLANDER: Thanks for having me.

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